Food Allergy Update: You may Reconsider when to Introduce Certain Foods

Infants who get a taste of eggs and peanuts starting when they’re as young as 4 months old may have a lower risk of developing allergies to those foods than babies who try them later, a research review suggests.

With eggs, giving babies that first spoonful between 4 and 6 months was associated with 46 percent lower odds of egg allergies than waiting to introduce this food later.
For peanuts, offering infants a sample between 4 and 11 months was associated with 71 percent lower odds of peanut allergies than waiting longer.

These recent findings suggest that for most babies, eggs, and peanuts should be among their first foods. Feeding guidelines have moved away from telling parents to avoid introducing some foods that can cause allergies until kids are 2 or 3 years old, but most recommendations still stop short of urging parents to give babies eggs and peanuts early in life.

When 5.4 percent of the population has egg allergies, early introduction could avoid 24 cases for every 1,000 people, a review of data from five of those studies with 1,915 participants found. For peanuts, when about 2.5 percent of the population has allergies, early introduction could avoid 18 cases for every 1,000 people, a review of data 1,550 participants found.

Researchers didn’t find enough evidence to determine whether early introduction of fish might reduce the likelihood of allergies in general and nasal allergies in particular. They also looked at whether giving babies gluten, a protein in wheat, rye and barley, early might increase the risk of celiac disease, an autoimmune disorder that damages the small intestine and interferes with the absorption of nutrients from food.

Most infant feeding guidelines consider exclusive breastfeeding for the first six months to be ideal, but few women meet that goal, and many who do breastfeed their babies for six full months still introduce solids starting around age 4 months.

Still, for most children, parents probably don’t need to consult a doctor before introducing these foods. Most children are not at risk for developing food allergy and thus, they wouldn’t need any specific intervention or supervision.

The picture is different for kids who have a high risk of developing food allergies, which can include children with severe eczema, an existing food allergy or a sibling with a peanut allergy.
Parents of at-risk kids should consult a doctor or allergy specialist before introducing foods that can trigger an allergic reaction. The current research review doesn’t address how much egg or peanut to give kids, or how often. And of course, a 4-month-old can choke on whole peanuts, and should get this food in peanut butter form.

The current study adds to a growing body of evidence suggesting that early introduction of eggs and peanuts can help at least some children develop a tolerance to these foods who would otherwise be allergic.

SOURCE: JAMA, online September 20, 2016.